Uniform Mitigation Verification Inspection Form
A uniform mitigation verification inspection form is a document used for inspecting an individual’s house so that the person can get discount from insurance companies whenever he gets his house insured. A person qualifies for insurance discount only if he has gone through this inspection.
Sample Uniform Mitigation Verification Inspection Form:
Information of the owner:
Name: ___________
Address: _________________________
Home contact number: _____________ Work contact number: _____________
Mobile phone number: __________
Name of insurance company: ________________ Insurance Policy number: ___________
Year of purchasing the house: ________________
a) Roof covering details:
_______________________________________
_______________________________________
b) Building code:
__________________________________________________
___________________________________________________
c) Construction type of the wall:
_________________________________
__________________________________
d) Roof to wall attachment:
_____________________________________
______________________________________
_________________________
Signature of the owner
Dated: ______________
Details of the inspector:
Name: ______________________
Inspection Company: __________________________
License number: ____________________
Contact number: _____________________
I certify that the information provided by the owner is true to the best of my knowledge.
____________________________
Signature of Inspector
Dated: ______________
Category: Verification Forms
